The head of the fibula is the expanded proximal end of the fibula, forming the proximal tibiofibular joint with the posterolateral facet of the lateral tibial condyle. The fibular head presents a styloid process superiorly for attachment of the fibular collateral ligament and biceps femoris tendon, and its medial surface bears the articular facet. The common peroneal nerve winds around the posterior aspect of the fibular neck immediately below the head.
| Articulations |
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|---|---|
| Landmarks |
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| Ossification | Ossifies from a secondary centre appearing at about 3-4 years, later than the distal fibular centre, and fuses with the shaft at about 17-20 years. |
The fibular head is a critical surgical landmark because the common peroneal nerve wraps around the neck of the fibula immediately distal to the head, making this the most vulnerable site for peroneal nerve injury from plaster cast pressure, direct blows, crossing the legs, and surgical positioning. Biceps femoris tendinopathy and LCL injuries are assessed by palpation at the fibular head. Proximal tibiofibular joint instability produces lateral knee pain and a subtle anterior fibular head prominence.
Bend the knee to 90 degrees and find the biceps femoris tendon on the outer back side of the knee. Follow it down to where it ends on a rounded bony knob just below the joint line, roughly level with the tibial tuberosity; this is the head of the fibula. Avoid firm pressure just below it, where the common fibular nerve wraps around the fibular neck.
Compression of the nerve as it winds around the fibular neck from leg crossing, tight cast or brace, or direct trauma produces foot drop with loss of ankle dorsiflexion and toe extension, with numbness over the dorsum of the foot and lateral shin.
The LCL and biceps femoris tendon can avulse the fibular styloid in high-energy posterolateral knee injuries, an important indicator of posterolateral corner disruption requiring surgical repair.
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